10D2119851 CLIA NUMBER - PALM BEACH REGIONAL OPCO LLC

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Laboratory Demographics

CLIA Number: 10D2119851

Facility Name: PALM BEACH REGIONAL OPCO LLC

Facility Address:
11030 RCA CENTER DR STE 3001
PALM BEACH GARDENS, FL
ZIP 33410
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Facility Phone Number: 561 530-6620

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1003205196

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2119851
LAB Type	Ambulatory Surgery Center
Facility Name	PALM BEACH REGIONAL OPCO LLC
Street	11030 RCA CENTER DR STE 3001
City	PALM BEACH GARDENS
State	FL
ZIP	33410
Phone	561 530-6620
CertificateType	4
CertificateEffectiveDate	10/5/2022
CertificateExpirationDate	10/4/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024